Australia, Indonesia, modernity and breastfeeding
Australia, Indonesia, modernity and breastfeeding
By Alison and Rob Goodfellow
NEW SOUTH WALES, Australia (JP): In the past, many people innocently believed that among the blessings of modern science was a recipe for infant formula so close to mother's milk that the two were almost indistinguishable. Many mothers now know differently.
In Australia, for example, particularly during the years between 1950 and 1980, many women believed that the artificial alternative to breast feeding presented no real risks. It was maintained that as long as the formula was correctly prepared and was uncontaminated then there was no cause for concern. This was untrue. Significant nutritional and immunological differences exist between breast milk and milk formula.
Various claims that formula is close in consistency to mother's milk stretch the truth. First of all, all formulas differ. Some have similar protein levels to breast milk, others have similar quantities of essential minerals. However, none ever come close to being able to adequately represent the dynamic qualities of breast milk.
Colostrum, the first milk produced before and after birth is full of living cells. Eighty percent to 100 percent of cells in colostrum are phagocytes, which ingest yeast cells. (These cause conditions such as thrush). As well as this, mother's milk contains many basic antibodies that are bacteriostatic for a number of dangerous microorganisms. Breast milk protects against Escheriocha-coli, Vibrocholerae and Enterovirus, all of which can cause severe infections in the newborn. Breast milk also protects the baby from diarrhea.
Because all mothers are constantly exposed to pathogens in their respective environments, a particular woman will produce specific antibodies which are then passed on to her infant through breast milk. This can provide up to one year's immuno- protection for the child. There is no possibility that a manufacturing process could ever tailor make a milk to satisfy the different demands of each infant.
The composition of mother's milk changes from day to day and mother to mother. Breast milk is able to meet the individual needs of each infant. Even during feeding, the composition of the milk can change. If a baby suckles strongly, as big babies do, then there will be more fats in the milk. Or if a mother is malnourished the amount of milk will be diminished but there will still be adequate fat and protein available to the baby.
Compare this with a poor mother in either a developing nation, or for that matter a developed one. Because poor mothers cannot afford to buy formula they often make the tin last longer by making weak mixes. This results in a malnourished child. It is important to reinforce the fact that children actually die of starvation this way. When we see pictures of women in famine stricken nations breast feeding, the breast looks shrunken and empty. However it is not until after weaning that starvation syndromes begin to emerge in the child.
Significantly, in the newborn period, and throughout infancy and early childhood, maximum growth occurs in brain tissue. Mothers who have preterm infants (that is born before 36 weeks) secrete milk which is different in composition to that of a mother with a full term infant. Recent studies have shown that human milk plays an important role in the intellectual development biology of the newborn. Interestingly, in 1960, breast feeding was at an all time low in the United States. Significantly, in the same year, the measurable national U.S. I.Q. level also dropped to a record low.
The metabolic response (the way the whole body operates) to feeding is different in breast fed, as compared to formula fed infants. These differences are attributed to the presence of growth factors, human hormones and other biological substances present in human milk. A correct balance of nutrients and other mechanisms governing their use is crucial during the period of rapid brain growth. This applies to even seemingly minor components of breast milk.
Between March 1978 and August 1979 it was found that two soya based formulae marketed in the United States and in Spain were deficient in chloride. Babies fed on this formula developed symptoms of chloride deficiency which include, failure to thrive, anorexia, lethargy and metabolic alkalosis with low levels of serum potassium. When these children were assessed four to five years later they were found to have a number of serious abnormalities.
One of these was a distinctive syndrome of cognitive impairment, language disorders, visual and fine motor difficulties, as well as a marked attention deficit syndrome. This occurred because, at that time, there was some controversy about salt and the association with heart disease. So formula companies thought they were doing the right thing by reducing salt (chloride) in their formulas. This is just one example of the type of mishap that can be caused by juggling the different nutrient balances of formula to try and match breast milk.
Before the 1960s, western babies were often fed on a variety of different types of whole milk. For example, dried, evaporated, and condensed milk. While none of these can compare with the complicated formulae of today, results from their particular inadequacies further reinforce the danger of the artificial alternative. These included high morbidity and mortality from infection, malnutrition, brain damage and anemia. More specific problems included low levels of folic acid and vitamin C, which caused megoblastic anemia.
There were also problems such as fits, cerebral palsy and mental retardation caused by formulas being deficient in pyridoxine (a type of B vitamin). Excessive protein in formula was responsible for dehydration, uremia and brain damage. Other maladies included scurvy, skin disorders, eye disorders, failure to thrive and diarrhea.
At the time, all of these were obvious problems, which were recognized quickly. However, formula companies still took too long in modifying their product. Perhaps it was because there were no regulations to monitor defective formula and no legal backlashes to impede domestic and foreign sales.
Between the 1970s and 1980s other problems arose as formula companies further modified their product with often disastrous results. Minchin in her book, Breastfeeding Matters, lists maladies such as bowel obstruction in preterm infants caused by indigestible curds in the milk and fits from low levels of calcium. There was also frequent reports of contamination from lead and other heavy metals contained in the liner of formula tins. There were numerous product re-calls during this time because formula was curdled, discolored, smelt or just looked "off". These problems were not just recognized in and isolated to affluent countries. India, unfortunately, imported a western manufactured formula which contained high copper levels. This "error" caused severe liver disease in thousands of otherwise healthy Indian infants.
In addition to these issues, questions still need to be asked about diseases that develop in later childhood and even adulthood and whether these are related to a family history of artificial feeding. Why, for instance, is it that the chance for a successful kidney transplant is higher if the patient was breast fed. What other long term immunological effects may be uncovered? One question that could be asked in relation to multiple sclerosis is, what relationship exists between the low levels of fat in formula and the development of de-myelination disorders.
At this point, all this information should be put into a global perspective. More babies die from diarrhea every two and a half days than have ever have died from the AIDS virus. In the third world, diarrhea is directly exacerbated by bottle feeding because there is often no readily available source of clean water, because sterilizing techniques for bottles and teats are inadequate and because fuel to boil water is in short supply. Milk is an excellent medium for bacteria to multiply in. In hot climates this happens very quickly.
However, it is important to remember that dehydration in babies is not just a third world problem. Studies in Australia have shown that in every level of society there are findings of incorrectly made formula and the associated problems like those already mentioned. The important issue then is that, regardless of the source of powder or scoop design, the basic method is incapable of delivering feeds with the necessary degree of accuracy. It could be concluded then that there is little point in manufacturers producing more advanced formula with specific levels of minerals and vitamins if the method of reconstitution is inherently inaccurate.
The other inherent problem with formula is, as already mentioned, cost. It may come as a surprise to many Indonesians that even in so-called "rich nations" there is an underclass living in desperate poverty. For some Australians this makes breast feeding a matter of infant life or death. Infant mortality rates from Australian Aborigines reflect this serious problem. And while it is now accepted by health workers that poverty is the greatest enemy of children, the good news is that the health of Australian children has improved with an increase in breast feeding.
If you add to these issues the fact that, ecologically, bottle feeding has a negative effect on the environment as opposed to breast feeding, then you can begin to appreciate the scope of the problem. Breast milk is a natural renewable source, which is intended to be fed to babies, while artificial feeds are processed, non-renewable substitutes. There is no waste from breast milk as it works on a supply and demand method of production. This can be compared to artificial milk that creates a demand, then supplies for a price. Breast milk production does not pollute. It is free and requires no packaging. Finally, of great significance to women themselves, is the fact that breast feeding significantly reduces the chances of the mother developing breast cancer (which now affects one in eight Australian women).
The eminent nutritionist Vahlquist wrote in 1976, "Obviously new discoveries have widened the gap between human milk and even the most ambitious and sophisticated of formula. No doubt the artificial feeding industry will make every effort to produce a new formula which comes ever closer to human milk, at least superficially. But attempts to bridge the gap will remain futile since we are a dealing here with such complex systems and such species-specific substances that even the most costly substitute cannot be foreseen to reach the ideal model. Thus new discoveries in the field of the 'species-specificity' of human milk will serve to underline very strongly the uniqueness and biological superiority of this product of nature."
Clearly the Indonesian government has a good appreciation of the importance of these issues. In his 1991 Presidential Decree, President Soeharto strongly encouraged Indonesian women to breast feed. And while many Indonesian women continue to believe that bottle feeding is somehow superior, Australian women are increasingly discovering that to raise a healthy, happy and intelligent breast fed baby is truly an expression of a "modern society".
Alison Goodfellow is a clinical liaison midwife with the Illawarra Regional Hospital, Wollongong, NSW, Australia and The Charles Stuart University. Her husband, Rob Goodfellow, is a frequent contributor to The Jakarta Post.